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Evaluation of dementia in the cardiovascular health cognition study
Oscar L Lopez1, Lewis H Kuller, Annette Fitzpatrick
1Department of Neurology, University of Pittsburgh School of Medicine, Pa 15261, USA.
Insights
This study developed a dementia evaluation method for large groups, finding varying dementia prevalence across demographics. The Cardiovascular Health Study (CHS) provides a robust model for future dementia research.
Area of Science:
- Neuroscience
- Epidemiology
- Gerontology
Background:
- The Cardiovascular Health Study (CHS) is a longitudinal study focusing on cardiovascular disease in individuals over 65.
- A subset of 3,608 participants underwent brain MRI in 1991, forming the cohort for dementia assessment.
- Cognitive function was monitored yearly, with detailed dementia evaluations conducted between 1998 and 2000.
Purpose of the Study:
- To outline a methodology for evaluating dementia within a large, longitudinal cohort.
- To determine the frequency and prevalence of different dementia types.
- To assess the prevalence of dementia and mild cognitive impairment (MCI) in the CHS cohort.
Main Methods:
- Utilized data from the Cardiovascular Health Study (CHS) cohort.
- Included yearly cognitive function assessments and comprehensive neurological/neuropsychological examinations for dementia diagnosis.
- Employed a review committee of neurologists and psychiatrists for adjudicating dementia and MCI cases.
Main Results:
- Identified 13.3% incident dementia and 6.3% prevalent dementia cases.
- Classified incident dementia types: 69% Alzheimer's disease (AD), 11% vascular dementia (VaD), 16% mixed, 4% other.
- Dementia prevalence varied by race and sex, with higher rates in Black men (22.2%) and women (23.4%) compared to white men (13.5%) and women (14.5%).
Conclusions:
- The CHS successfully developed and implemented a robust methodology for longitudinal dementia studies in large populations.
- This study represents a significant contribution to dementia research, integrating cognitive testing, MRI, and genetic markers.
- The findings highlight the importance of demographic factors in dementia prevalence and underscore the value of the CHS methodology for future research.
Objective:
To describe a methodology to evaluate dementia and frequency of different types of dementia and prevalence of the Cardiovascular Health Study (CHS).
Methods:
The CHS is a longitudinal study of cardiovascular disease among community-dwelling individuals over the age of 65. Of the 5,888 participants in the original study, 3,608 had a magnetic resonance imaging (MRI) of the brain in 1991, and formed the cohort for the dementia study. The CHS included yearly measures of cognitive function and, from 1998 to 2000, participants were evaluated for dementia by detailed neurological, and neuropsychological examinations. The possible cases of dementia and mild cognitive impairment (MCI) were adjudicated by a review committee of neurologists and psychiatrists.
Results:
There were 480 cases of (13.3%) incident dementia in the total sample, 227 (6.3%) prevalent dementia, 577 (16.0%) MCI, and 2,318 (64.4%) normal. The adjudication committee classified 69% of the incident dementia as Alzheimer's disease (AD), 11% as vascular dementia (VaD), 16% as both, and 4% as other types. There was a substantial agreement between pre- and postMRI diagnosis of types of dementia. The frequency of dementia within the CHS cohort which survived to the end of the study in 1998-1999, was 13.5% for white men, 14.5% for white women, 22.2% for black men and 23.4% for black women.
Conclusion:
The CHS has developed a methodology for longitudinal studies of dementia in large cohorts and represents the largest study of dementia including cognitive testing, MRI and genetic markers.